Medical practices of all sizes don’t pay attention to claims that get denied. Most of them just believe in submitting the claims, start expecting insurance reimbursements. There is no claim tracking, no claim follows up involve. After a few months, they will start realizing they are working more and earning less. Claim denials are the obvious reason for reducing insurance reimbursements. When you submit a claim, the payer can either pay it or deny the payment with a suitable denial reason.
Provider or billing staff need to study these denial reasons and resubmit the claim with changes or additional information. Common claim denial reasons include missing or incorrect data; patient eligibility; lack of medical necessity; duplicate claim submission; lack of documentation; non-payable diagnosis codes; lack of prior authorizations; and wrong procedure codes. You can easily figure out that most of the common claim denials are easily avoidable. So, in this article, we have discussed 5 best practices to reduce claim denials. You will be surprised to know that about two-thirds of all denied claims are recoverable, even then also only 35% of them are resubmitted.
Just submitting claims is not enough, monitoring and documenting each of your practice’s claims and denials is crucial. It enables you to ensure claims are submitted and appealed in a timely manner, spot trends in denials, and maintain detailed oversight of the portion of the claims of your revenue cycle. Each patient encounter ideally should be coded on the date of service. Denied claims should be tracked by type and payer when posting payments or at other regular intervals.
Routinely run a detailed report of your practice’s denied claims. Though the reason(s) for denial typically varies by specialty and practice, this report allows you to more easily pinpoint specific claims without having to sift through multiple ones. Also consider maintaining a log listing your denials, including the type of denial, the date it was received, and the date you appealed it. If you notice a problematic trend through this documentation, address it immediately to avoid additional claim denials. After gathering denied claim data, if you focus on top 3 denial reasons you will be recovering more than 80% percent of your lost reimbursements.
Knowing the denial rate of your practice lets you target areas that are especially troublesome for your revenue cycle. We suggest the following method to calculate your practice’s denial rate: add the total dollar amount of claims denied by payers within a given period and divide by the total dollar amount of claims submitted within the given period. If possible, your rate should also be computed by payer, provider, and reason for denial.
Knowledge of complex and changing documentation requirements (i.e., ICD-10) and accurate data entry are key for billing staff to correctly and expediently handling the claims process. Ensure you have adequate staffing to process claims and communicate regularly with your team members about policies and procedures that affect denied claims. Emphasize regular training to keep employees updated on the new or updated procedure and diagnostic codes, appeals processes, and instructions particular to each payer.
The eligibility and benefits verification process ensures that you will receive all the reimbursement you deserve. It will help you to understand if the patient has active coverage or not; what services are included; what is patient responsibility; is there any need for prior authorization and many others. Eligibility check before every patient visit will ensure that you will have all the correct information to fill the claim, which makes fewer chances of the claim getting denied. You can simply call the insurance rep and understand patient coverage; payable procedure codes, and understand the medical necessity.
Above mentioned 5 best practices will definitely help to reduce claim denials. To implement these 5 best practices, you will require the provider’s time and expert medical billing staff. As the providers are busy in patient care and expert medical billers are difficult to retain, outsourcing your billing could be a practical solution for denial management.
Medical Billers and Coders (MBC) provides denial management and resolution service which includes eligibility verification; clean claim submission; claim tracking; accounts receivable (AR) management; and reporting. All these functions are conducted by billing and coding experts as per your medical specialty. If you want to know how we can assist you in reducing claim denials and increasing insurance reimbursements, contact us at info@medicalbillersandcoders.com/ 888-357-3226.
